Part of palliative care is maintaining the dignity of the patient before and even after death. This is because reliance on the patient on the nurses and other caregivers erodes the sense of dignity. Once day-to-day deterioration has begun in the patient and when the situation has come that death can occur any time, the patient must be provided holistic comfort, symptoms must be managed properly, he or she must be given minimal drugs, the wishes must be upheld, anxiety levels must be alleviated and her fear, religious needs, and spiritual needs must be addressed by telling the patient that r family is around (National Cancer Control Programme, 2005).
There are 3 main themes in maintaining dignity and they are "the unrecognizable body, fragility and dependence and inner strength and a sense of coherence" (Hall, Longhurst and Higginson, 2009). Dignity in the patient can be upheld by allowing the patient to do as many activities as possible and by treating the patient with respect. The WHO's Pain Relief Ladder is a useful guide to prescribe medications for pain (WHO, 2009) (Refer to Fig. 2).
This ladder consists of 3 steps of pain from below to up. The lowest is the step of mild pain. Mild pain is that pain which is self-limited and may or may not require treatment. The next step is moderate pain. This pain is worse than mild pain and it affects functions of the individual. The presence of pain cannot be ignored. This pain goes away with treatment and seldom reappears. The uppermost step is that of severe pain. This pain interferes with most of the daily living activities.
The individual may need treatment for many weeks, months or even years. According to this guide, the first drugs which must be recommended for pain are non-opioids like paracetamol and non-steroidal anti-inflammatory drugs or NSAIDs like aspirin and ibuprofen. Then if necessary, the treatment must be stepped up to mild opioids like codeine and then to strong opioids like morphine, hydrocodone, oxycodone, methadone, hydromorphone, and fentanyl until the patient is relieved of pain. Generally, chronic pain is associated with anxiety and fears, adjuvants like anti-anxiety drugs may be given.
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